Treatments for Rheumatoid Arthritis

Rheumatoid arthritis is a chronic, systemic inflammatory disorder that attacks the joints, producing inflammatory synovitis that often progresses to destruction of the cartilage and causes fixation of the joints, and in some cases can affect tissues and organs. Rheumatoid arthritis can also produce inflammation in the lungs, heart, eyes and under the skin. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in its chronicity and progression.

About 1.3 million Americans suffers from rheumatoid arthritis, which strikes women three times more often than men. The onset is most frequent after forty, but people of all ages are susceptible. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility. It is diagnosed chiefly on symptoms and signs, but also with blood tests (especially a test called rheumatoid factor) and X-rays. Diagnosis and long-term management of rheumatoid arthritis are typically performed by a rheumatologist, an expert in the diseases of joints and connective tissues. Almost half of patients experience destruction of cartilage and bone within a few months of symptom onset.

Treating Rheumatoid Arthritis

There are various treatments available for rheumatoid arthritis. Most experts recommend that disease-modifying antirheumatic drugs (DMARDs) should be started within three months of diagnosis for most patients since, unlike Osteoarthritis, drugs do affect the course of the disease. While analgesia (painkillers), anti-inflammatory drugs and steroids are used to suppress the symptoms, disease modifying anti-rheumatic disease drugs (DMARDs) can actually inhibit or halt the underlying immune process and prevent long-term damage. DMARDs are the cornerstone of rheumatoid arthritis treatment, and are appropriate for most patients. NSAIDs like ibuprofen and corticosteroids can help treat the symptoms such as pain and swelling, but they don't prevent joint destruction. Non-pharmacological treatment for rheumatoid arthritis includes physical therapy, acupuncture and occupational therapy.

Treatment decisions are based on the patient's disease activity, disease duration, and prognosis. A poor prognosis is dictated by the degree of functional limitation, the presence of disease outside the joints, positive rheumatoid factor and/or antibodies, and/or bony loss. The expected duration of rheumatoid arthritis is another factor that will affect the treatment(s) your doctor recommends. A disease duration of less than six months is considered early disease, six to twenty-four months is considered intermediate duration, and over twenty-four months is long-duration disease.

How Duration Affects Treatment

Nonbiologic DMARDs for Rheumatoid Arthritis

Methotrexate can be combined with leflunomide for high disease activity in multiple settings. Another popular combination is methotrexate plus sulfasalazine. This combination is considered "step-up" therapy for patients who respond poorly to a treatment regimen of sulfasalazine alone. Hydroxychloroquine plus sulfasalazine can be recommended in other settings. The most-studied triple combination is methotrexate, sulfasalazine and hydroxychloroquine. It is more effective than methotrexate plus sulfasalazine. All of these regimens are used in differing settings depending on severity, duration and other factors found in each patient.

Biologic DMARDs for Rheumatoid Arthritis

For patients with intermediate or long-duration disease who have failed no biologic DMRAD therapy, anti-TNF alpha agents can be used. Anti-TNF alpha agents like the T cell inhibitor abatacept (Orencia) and the B-cell inhibitor rituximab (Rituxan) are also options if moderate or high activity disease persists despite nonbiologic DMARDs. The anti-tumor necrosis factor alpha (anti-TNF alpha) agents (e.g., etanercept [Enbrel], infliximab [Remicade], adalimumab [Humira] can be used with methotrexate in patients with early disease of high activity who have not been previously treated with DMARDs. Combinations of biologic DMARDs are not recommended for patients with rheumatoid arthritis, because the risk of adverse effects is increased without added benefit.

Author’s Note: References: www.prescribersletter.com, www.mayo.com, www.medscape.com, www.wikipedia.org.

Posted in Relieving Symptoms, Senior Health, Types of Arthritis